Dr. Lexi Tabor-Manaker’s office doesn’t look like the typical medical waiting room. It’s quiet - more like a business lounge than a hospital - with natural light and snacks. In fact, there isn’t a waiting room at all, or a receptionist, or anyone besides Tabor-Manaker herself.
Tabor-Manaker is the only employee of Glacier Direct Primary Care in Kalispell, her venture to bring an alternative model of primary and preventative health care to the Flathead Valley.
When she was a kid growing up in Michigan, Tabor-Manaker dreamed of both being a doctor and living with a view of Glacier National Park, where she frequently visited relatives. She combined the two goals 11 years ago when she moved to the Flathead Valley with her husband. But working as a primary care physician as part of a larger practice wasn’t all that she dreamed it would be. There were more and more patients to see, but less time to spend with them, as billing, coding and navigating the complex world of insurance claims increasingly consumed her working hours.
With the compounding non-medical duties, “it didn’t feel like I was able to give the kind of quality of care that I’m used to giving and that I need to give,” she said.
The frustration only continued when Tabor-Manaker transitioned to primary care work at the VA. “I really loved caring for the veterans. But in a government setting, there were even more obstacles to provide the kind of care I knew my patients needed.”
Over time, the Tabor-Manaker’s frustration over having her attention drawn to the computer, not the patient, developed into a “cloak of despair and burden” that left her feeling “wrung-out.” This wasn’t what she intended health care to be.
After a particularly demoralizing day of feeling like she wasn’t doing enough to help her VA patients, she said, a colleague commented to her, “You know, Lexi, the system does not value what you have to offer.”
She ruminated on that comment for days, thinking, “You’re right. I have to get out of medicine, but I don’t want to get out of medicine. I love being a doctor.”
“The system doesn’t value what I have to offer,” she decided. “But you know who does? Patients do. And I do.” That’s when she started looking into direct primary care.
Direct primary care is an alternative model to delivering medical care that eschews insurance entirely. Typically, doctors and medical practices bill insurance per visit or service, a method that has led to more physician time spent on documentation, coding and billing. It has also driven up the costs of medications and service, say advocates of direct primary care.
Direct primary care aims to simplify the delivery of primary and preventative medicine by minimizing regulatory hurdles. “My whole thing has been to nix the middle man, so that I am dealing with patients directly, which has a lot of benefits,” said Tabor-Manaker.
According to Tabor-Manaker, these benefits include a strong one-on-one patient-doctor relationship, more time spent on appointments, quick access to one’s physician and decreased costs for medications and services.
After talking with several direct primary care physicians around the country and attending a national conference, Tabor-Manaker decided that it was the path for her. With the help of the Western Montana Economic Development Fund, which she said was “instrumental” in helping her launch, Tabor-Manaker opened Glacier Direct Primary Care earlier this year.
There are over 1,000 direct primary care physicians nationwide, but only a handful in Montana. Besides Dr. Doug Pitman, who works part time in Whitefish, Tabor-Manaker is the only direct primary care physician in the Flathead.
Tabor-Manaker does not accept any form of insurance - which allows her the time to be Glacier Direct Primary Care’s only employee - though she encourages patients to maintain insurance for emergencies or “big-ticket” costs, such as surgeries.
Instead, patients pay her a monthly fee based on age - 80 for 40-54, 120 for 65-98, 200 cap for families, though she currently does not take patients under age 18. Businesses can fund groups of five or more employees for 100 intake fee, Tabor-Manaker’s patients have constant access to her for medical questions, after-hour appointments and consultations on everything from chronic conditions to healthy lifestyle changes. Time not spent on coding or billing can go to lengthy appointments with her patients. Additional costs such as prescriptions or X-rays are paid out of pocket by patients, though, she said, she often negotiates the prices for medications and services down to a fraction of the cost.
Tabor-Manaker and other direct primary care physicians describe the model using a “car insurance analogy.”
People own car insurance, she said, for emergencies, accidents and other major repairs. “We don’t expect our insurance to pay for wiper blades, gas, tires - we budget for that. We know that that’s going to be part of owning a car.”
Medical insurance, she said, was originally intended for a similar purpose - “for major medical issues and catastrophic things, big-ticket items, and patients were expected to be able to budget for the small items.”
However, “when the small items now cost hundreds and hundreds of dollars because of all the layers and all these regulations, the prices aren’t cheap enough for people to be able to budget for primary care anymore. And so they’ll just avoid it all together, a lot of times.”
Tabor-Manaker is aiming to keep people out of emergency rooms by creating time and opportunity for comprehensive primary care.
For example, she said a recent intake visit lasted 2.5 hours because she and the patient went through their entire medical history to establish goals and boundaries. “And I love that I am able to do that, because I’m my own boss, but that also is just good medicine.”
That level of comprehensive care and access, she said, “just feels right to me.”
Spending more time with her patients, negotiating for medication and service prices on their behalf and building an open dialogue on health, she said, “gives patients an opportunity to take better care of themselves because there’s less barriers to care.”
Sitting in her new office, she schedules a patient appointment on one hand and plans a pitch to help a local small business’ employees on the other. Her venture into direct primary care is a careful balance, but looking back on her period of burn-out, she shakes her head at the risk.
“This has not necessarily been easy, but it was necessary. What I’m doing is necessary for me, and I think it’s necessary for the community.”
For more information, visit www.glacierdpc.com.
Reporter Adrian Horton can be reached at email@example.com or at 758-4439